| Presenter: Michael DeLong, BA, Duke University
Authors: Michael DeLong (1), Kyle Halvorson (2), John Gallis (2), Carrie Muh (2), Shivanand Lad (2), Jeffrey Marcus (3)
(1) Duke University, Chapel Hill, NC, (2) Duke University, Durham, NC, (3) Duke Univ Med Ctr, Durham, NC
Michael DeLong, BA
Surgical intervention for craniosynostosis varies widely with regards to type of repair and age at first operation. Postoperative adverse events and eventual reoperation rates secondary to this variability have not been completely defined, particularly as less invasive methods have gained popularity.
All non-syndromic craniosynostosis patients who underwent surgical repair and had a recorded birth date were selected by CPT/ICD 9 codes from the Thompson Reuters Marketscan Database. Logistic regression models were used to compare 90-day adverse event rates according to age at surgery and procedure used. Relative reoperation events were assessed using Cox proportional hazards modeling. Fisher exact testing was used to determine impact of gender.
Of 1232 patients, 644 (52.3%) underwent surgical repair between 0 and 6 months, 471 (38.2%) between 6 and 12 months, and 117 (9.5%) between 1-3 years. Variations of strip craniectomy alone were performed in 515 (44.3%) cases, and cranial vault reconstruction (CVR) was performed in 647 (52.5%). Surgical intervention between 6 and 12 months of age was associated with increased incidence of ICD9-defined hemorrhagic events and transfusions compared to earlier repair (hemorrhagic 6.2% vs 3.0%, transfusion 26.3% vs 21.3%, both p < 0.05). Additionally, ICD9-defined hemorrhagic events were more frequently observed in male patients (5.0% vs 2.3%, p = 0.03). Lastly, repair with CVR was associated with an increased reoperation rate compared to repair with strip craniectomy (8.7% vs 2.9%, p < 0.001).
Repair between 6 and 12 months and male gender may increase the risk of adverse bleeding events in craniosynostosis patients. Additionally, CVR surgery appears to increase eventual reoperation rate compared to strip craniectomy.